- Email: [email protected]
Endometrial health of bariatric surgery candidates
S190
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
Dalinde, Ciudad de Mexico, Mexico; 2Centro Bariatrico Metabolico Dalinde, México, Distrito Federal; 3Centro Medico Dalinde, México, Distrito Federal Background: The intrabdominal space is a need for the surgeon. The lack of neuromuscular relaxation reflects in a lack of space, conditioning technical difficulties and causing CO2 flow increase. Tissue hypoxy and hemodynamic changes can be high risk for the patient. The objective of the study was finding out if there are changes in the intrabdominal space with the use of the Deep neuromuscular blockade with a low CO2 preassure. Material and Methods: 30 operated patients in a prospective, comparative and transversal study. Inclusion guideline: ASA 2-3, 18-60 years old for emergency and elective laparoscopy surgery. with IMC 4 35m2 Exclusion guideline: patients with peritonitis
or intrabdominal bleeding. The patients were handled with general balanced anaesthesia, with rocuronium as a neurumuscular blockade (0.8mg/kg dose).(calculad Once TOF 0 PTCþ3 was obtained a measuring of the abdominal cavity was performed. We applied 0.3 mg/kg and we waited for 2 minutes. The obtaining of TOF 0 PTC 0 was verified and we performed a second measuring of the abdominal cavity. All the procedures were carried out with an intrabdominal preassure of 12 mmHg. Results: 30 patients, 22 (62.8%) female and 13(37.1%) male, with an age average of þ-45,2 years old. The majority of the patients had an ASA 3 (68%). The difference in the second measuring with deep neuromuscular blockade was significantly higher compared to the first measuring with Deep neuromuscular blockade (p¼0.052), with an average of 7.20 cm (STDEV 0.76) for the first measuring and 8.53 cm (STDEV 1.04) for the second one. Conclusions: If we use Deep neuromuscular blockade in laparoscopic procedures,for patiens obese we will obtain better surgery conditions with a low abdominal preassure, and we will better ventilation diminishing morbility and mortality related to pneumoperitoneum.
A5245
ENDOMETRIAL HEALTH OF BARIATRIC SURGERY CANDIDATES Faina Linkov, MPH, PHD; William Gourash, MSN CRNP; Ramesh Ramanathan, MD; Freese Kyle, MPH, CPH; Giselle Hamad, MD; Carol McCloskey, MD; University of Pittsburgh, Pittsburgh, PA, USA Introduction: Severely obese women undergoing bariatric surgery are an excellent group to target for endometrial cancer prevention research as they are at high risk for the development of endometrial abnormalities. Little is known about the prevalence of prior gynecologic procedures (hysterectomy and endometrial ablation) that would prevent the study of endometrial health in this population. This study documents the prevalence of hysterectomy and endometrial ablation among a sample of women undergoing bariatric surgery. It also documents reasons for endometrial biopsy failure in a group of women with uteri that our group attempted to sample for endometrial health assessment. Methods: This analysis includes 111 consecutive, adult female bariatric surgery candidates being screened for participation in a prospective cohort study examining endometrial health between February 2013 and June 2014. We also investigated reasons for endometrial biopsy failure for 48 women with uteri undergoing pipelle endometrial screening. Descriptive statistics were used to illustrate central tendencies of variables. Wilcoxon rank sum tests (continuous variables) and chi-squared tests (categorical variables) were used to compare characteristics between those with and without a history of hysterectomy or endometrial ablation. Results: Participants were aged 43 (Interquartile Range (IQR): 33, 53) years, 85% Caucasian, and had a median BMI of 44.17 kg/m2. Twenty-four (21.62%) women reported a history of hysterectomy or endometrial ablation. In women with attempted biopsies, common reasons for biopsy failure were inability to locate the cervix, stenosis of cervix, and inability to collect sufficient sample of endometrial tissue.
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
S191
Conclusions: Further research is needed to investigate endometrial health in bariatric surgery candidates. As obesity and endometrial health research are increasing, the scientific community would benefit from improved knowledge about basic characteristics of this high-risk population. A5246
THE VALUE OF PREOPERATIVE TESTING IN PATIENTS UNDERGOING BARIATRIC SURGERY Wasef Abu-Jaish, MD; Kathyn Schlosser Medical Student Class of 2015; University of Vermont College of Medicine, Burlington, VT, USA Introduction: Before undergoing bariatric surgery, patients undergo a testing regimen intended to reveal absolute and relative contraindications to surgical procedures. The purpose of this study is to examine the influence of preoperative testing on surgical decision-making in a single bariatric practice. Methods: This was a retrospective chart review that underwent IRB approval and was conducted following HIPAA guidelines. Subjects included patients of a single surgeon who underwent preoperative workup for bariatric surgery between Jan 2009 and June 2014. Preoperative tests included right upper quadrant ultrasound, esophagogastroduodenoscopy with pathological sample, and upper gastrointestinal series. Endpoints examined included whether a patient proceeded to surgery, and what surgery was performed (laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, hiatal hernia repair or other). Results: 89 patients underwent partial or complete preoperative workup for bariatric surgery. Of these patients, 243 (62%) underwent surgery, and 226 underwent uncomplicated and successful bariatric surgery (58%). Logistic univariate models showed that Table A: The tests, the Relave and Absolute contraindicaons Table A Test
Findings: Relative contraindications
Findings: Absolute contraindications
Upper Gastrointestinal Series with Contrast
Esophageal dysmotility: patient is referred for esophageal manometry test. If esophageal manometry is abnormal, relative contraindication for LSG.
Esophageal lesions: require more testing, possible preoperative resection (leiomyomas, duplicated cysts)
Hiatal hernia: relative contraindication for LSG OR indication for cruroplasty
GERD with documented esophagitis: absolute contraindication for LSG
GERD: relative contraindication for LSG. Esophagogastroduodenoscopy: Large Hiatal hernia: relative image and biopsy contraindication to LSG, or indication for cruroplasty Multiple gastric body polyps: relative contraindication to RYGB
Esophagitis: absolute contraindication for LSG Barret’s esophagus: Absolute contraindication for LSG
Active Malignancy: absolute contraindication to all bariatric Helicobacter pylori infection: procedures requires preoperative eradication, will be associated with gastritis, peptic ulcer disease. Right Upper Quadrant Ultrasound
Cholelithiasis: may indicate cholecystectomy Liver cirrhosis: relative contraindication to RYGB
patients with a relative contraindication to bariatric surgery on EGD were less likely to proceed to surgery (p ¼ 0.000, p o0.020, respectively). Of patients who underwent successful bariatric surgery, 207 (92%) received a laparoscopic sleeve gastrectomy, and 19 (8%) had a Roux-en-Y gastric bypass. Logistic univariate models showed that patients with gastric dysmotility on UGI were more likely to undergo Roux-en-Y bypass (po0.039). Multivariate logistic regression showed no other significant predictors of type of surgery performed, or whether a hiatal hernia repair was performed. Conclusion: Preoperative testing had minimal statistically significant influence on progression to surgery, or the type of bariatric surgery received by patients. Right upper quadrant ultrasound was of no utility in preoperative management. We found that both upper gastrointestinal series and esophagogastroduodenoscopy were of moderate use in preoperative management. As EGD is a higher yield test, we recommend EGD as a single standard preoperative test, with UGI to be performed in selected patients symptomatic for dysmotility, and RUQ US to be performed in patients with concern for hepatitis and/or biliary colic.
Cholecystitis: contraindication to immediate surgery
A5247
COMPARATIVE EFFECTIVENESS OF THREE BARIATRIC PROCEDURES: ROUX-EN-Y GASTRIC BYPASS, LAPAROSCOPIC ADJUSTABLE GASTRIC BAND, AND LAPAROSCOPIC SLEEVE GASTRECTOMY IN VETERAN PATIENTS Jenny Lee, PharmDCandidate1; Quynh Nhu Nguyen, PharmD, BCACP2; Quang Le, PharmD, PhD3; 1Western University of Health Sciences, Pomona, CA, USA; 2Veterans Affairs Loma Linda
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
Dalinde, Ciudad de Mexico, Mexico; 2Centro Bariatrico Metabolico Dalinde, México, Distrito Federal; 3Centro Medico Dalinde, México, Distrito Federal Background: The intrabdominal space is a need for the surgeon. The lack of neuromuscular relaxation reflects in a lack of space, conditioning technical difficulties and causing CO2 flow increase. Tissue hypoxy and hemodynamic changes can be high risk for the patient. The objective of the study was finding out if there are changes in the intrabdominal space with the use of the Deep neuromuscular blockade with a low CO2 preassure. Material and Methods: 30 operated patients in a prospective, comparative and transversal study. Inclusion guideline: ASA 2-3, 18-60 years old for emergency and elective laparoscopy surgery. with IMC 4 35m2 Exclusion guideline: patients with peritonitis
or intrabdominal bleeding. The patients were handled with general balanced anaesthesia, with rocuronium as a neurumuscular blockade (0.8mg/kg dose).(calculad Once TOF 0 PTCþ3 was obtained a measuring of the abdominal cavity was performed. We applied 0.3 mg/kg and we waited for 2 minutes. The obtaining of TOF 0 PTC 0 was verified and we performed a second measuring of the abdominal cavity. All the procedures were carried out with an intrabdominal preassure of 12 mmHg. Results: 30 patients, 22 (62.8%) female and 13(37.1%) male, with an age average of þ-45,2 years old. The majority of the patients had an ASA 3 (68%). The difference in the second measuring with deep neuromuscular blockade was significantly higher compared to the first measuring with Deep neuromuscular blockade (p¼0.052), with an average of 7.20 cm (STDEV 0.76) for the first measuring and 8.53 cm (STDEV 1.04) for the second one. Conclusions: If we use Deep neuromuscular blockade in laparoscopic procedures,for patiens obese we will obtain better surgery conditions with a low abdominal preassure, and we will better ventilation diminishing morbility and mortality related to pneumoperitoneum.
A5245
ENDOMETRIAL HEALTH OF BARIATRIC SURGERY CANDIDATES Faina Linkov, MPH, PHD; William Gourash, MSN CRNP; Ramesh Ramanathan, MD; Freese Kyle, MPH, CPH; Giselle Hamad, MD; Carol McCloskey, MD; University of Pittsburgh, Pittsburgh, PA, USA Introduction: Severely obese women undergoing bariatric surgery are an excellent group to target for endometrial cancer prevention research as they are at high risk for the development of endometrial abnormalities. Little is known about the prevalence of prior gynecologic procedures (hysterectomy and endometrial ablation) that would prevent the study of endometrial health in this population. This study documents the prevalence of hysterectomy and endometrial ablation among a sample of women undergoing bariatric surgery. It also documents reasons for endometrial biopsy failure in a group of women with uteri that our group attempted to sample for endometrial health assessment. Methods: This analysis includes 111 consecutive, adult female bariatric surgery candidates being screened for participation in a prospective cohort study examining endometrial health between February 2013 and June 2014. We also investigated reasons for endometrial biopsy failure for 48 women with uteri undergoing pipelle endometrial screening. Descriptive statistics were used to illustrate central tendencies of variables. Wilcoxon rank sum tests (continuous variables) and chi-squared tests (categorical variables) were used to compare characteristics between those with and without a history of hysterectomy or endometrial ablation. Results: Participants were aged 43 (Interquartile Range (IQR): 33, 53) years, 85% Caucasian, and had a median BMI of 44.17 kg/m2. Twenty-four (21.62%) women reported a history of hysterectomy or endometrial ablation. In women with attempted biopsies, common reasons for biopsy failure were inability to locate the cervix, stenosis of cervix, and inability to collect sufficient sample of endometrial tissue.
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
S191
Conclusions: Further research is needed to investigate endometrial health in bariatric surgery candidates. As obesity and endometrial health research are increasing, the scientific community would benefit from improved knowledge about basic characteristics of this high-risk population. A5246
THE VALUE OF PREOPERATIVE TESTING IN PATIENTS UNDERGOING BARIATRIC SURGERY Wasef Abu-Jaish, MD; Kathyn Schlosser Medical Student Class of 2015; University of Vermont College of Medicine, Burlington, VT, USA Introduction: Before undergoing bariatric surgery, patients undergo a testing regimen intended to reveal absolute and relative contraindications to surgical procedures. The purpose of this study is to examine the influence of preoperative testing on surgical decision-making in a single bariatric practice. Methods: This was a retrospective chart review that underwent IRB approval and was conducted following HIPAA guidelines. Subjects included patients of a single surgeon who underwent preoperative workup for bariatric surgery between Jan 2009 and June 2014. Preoperative tests included right upper quadrant ultrasound, esophagogastroduodenoscopy with pathological sample, and upper gastrointestinal series. Endpoints examined included whether a patient proceeded to surgery, and what surgery was performed (laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, hiatal hernia repair or other). Results: 89 patients underwent partial or complete preoperative workup for bariatric surgery. Of these patients, 243 (62%) underwent surgery, and 226 underwent uncomplicated and successful bariatric surgery (58%). Logistic univariate models showed that Table A: The tests, the Relave and Absolute contraindicaons Table A Test
Findings: Relative contraindications
Findings: Absolute contraindications
Upper Gastrointestinal Series with Contrast
Esophageal dysmotility: patient is referred for esophageal manometry test. If esophageal manometry is abnormal, relative contraindication for LSG.
Esophageal lesions: require more testing, possible preoperative resection (leiomyomas, duplicated cysts)
Hiatal hernia: relative contraindication for LSG OR indication for cruroplasty
GERD with documented esophagitis: absolute contraindication for LSG
GERD: relative contraindication for LSG. Esophagogastroduodenoscopy: Large Hiatal hernia: relative image and biopsy contraindication to LSG, or indication for cruroplasty Multiple gastric body polyps: relative contraindication to RYGB
Esophagitis: absolute contraindication for LSG Barret’s esophagus: Absolute contraindication for LSG
Active Malignancy: absolute contraindication to all bariatric Helicobacter pylori infection: procedures requires preoperative eradication, will be associated with gastritis, peptic ulcer disease. Right Upper Quadrant Ultrasound
Cholelithiasis: may indicate cholecystectomy Liver cirrhosis: relative contraindication to RYGB
patients with a relative contraindication to bariatric surgery on EGD were less likely to proceed to surgery (p ¼ 0.000, p o0.020, respectively). Of patients who underwent successful bariatric surgery, 207 (92%) received a laparoscopic sleeve gastrectomy, and 19 (8%) had a Roux-en-Y gastric bypass. Logistic univariate models showed that patients with gastric dysmotility on UGI were more likely to undergo Roux-en-Y bypass (po0.039). Multivariate logistic regression showed no other significant predictors of type of surgery performed, or whether a hiatal hernia repair was performed. Conclusion: Preoperative testing had minimal statistically significant influence on progression to surgery, or the type of bariatric surgery received by patients. Right upper quadrant ultrasound was of no utility in preoperative management. We found that both upper gastrointestinal series and esophagogastroduodenoscopy were of moderate use in preoperative management. As EGD is a higher yield test, we recommend EGD as a single standard preoperative test, with UGI to be performed in selected patients symptomatic for dysmotility, and RUQ US to be performed in patients with concern for hepatitis and/or biliary colic.
Cholecystitis: contraindication to immediate surgery
A5247
COMPARATIVE EFFECTIVENESS OF THREE BARIATRIC PROCEDURES: ROUX-EN-Y GASTRIC BYPASS, LAPAROSCOPIC ADJUSTABLE GASTRIC BAND, AND LAPAROSCOPIC SLEEVE GASTRECTOMY IN VETERAN PATIENTS Jenny Lee, PharmDCandidate1; Quynh Nhu Nguyen, PharmD, BCACP2; Quang Le, PharmD, PhD3; 1Western University of Health Sciences, Pomona, CA, USA; 2Veterans Affairs Loma Linda